Join Us for Florida Laws and the Nurse: New Licensure Requirement

Join Joanne Kenna nurse attorney with The Health Law Firm and the Greater Orlando Chapter of the American Association of Legal Nurse Consultants for:

FLORIDA LAWS AND THE NURSE – NEW LICENSURE REQUIREMENT:  Keep Your Patients Safe and Protect Your Nursing License

PROGRAM OBJECTIVES

The purpose of this is course is to provide nurses with knowledge of the Florida Laws and Rules that govern the practice of nursing in Florida, while meeting the 2015 requirement for Florida nurse licensure and renewal; and to provide valuable information regarding the structure and purpose of the Florida Board of Nursing Disciplinary Process and how to protect your nursing license by providing excellence in nursing care.

Upon completion of this course, you will be able to:

  • Describe the purpose and provisions of the Health Professions and Occupations Statue, the Florida Nurse Practice Act and Florida Health Professions Regulations;
  • Describe nursing standards of practice and identify deviations in standards;
  • List the steps in the Florida Nursing Disciplinary Process;
  • List specific sources of nursing practice that have high potential for putting a nursing license at risk of discipline.
  • Describe resources and procedures to protect your nursing license and respond to disciplinary action by the Florida Board of Nursing.

Beginning with the biennium ending in 2015, each Florida Nursing licensee must complete a two hour course on the laws and rules that govern the practice of nursing in Florida.  This program is approved by the Board of Nursing to meet the requirement.

SPEAKERS FOR THIS PROGRAM ARE:

ATTORNEY JOANNE KENNA, RN, JD is an attorney, whose practice encompasses most aspects of health law and nursing law, including the representation of health care providers in professional licensing and credentialing matters, professional board representation, administrative hearings, contracts, licensure issues, corporate matters, transactional matters and litigation.  Ms. Kenna received her juris doctorate degree from Stetson University College of Law.  She has an extensive legal background including medical malpractice defense and nursing home defense.  Prior to law school, Ms. Kenna’s nursing career included at the University of Chicago Hospitals and Clinics included being the head nurse of the cardiac critical care units, a cardiac nursing instructor and cardiac nursing consultant.  She brings a vast amount of experience and expertise to her role in health law.

JUDY A. YOUNG, RN, MSN, MHL is a nurse with over 38 years experience, 20 of which were served in the US Air Force.  Judy is the owner of Florida Legal Nurse Experts, LLC, and works as an independent Legal Nurse Consultant.  Judy’s LNC experience includes defense of mass torts / product liability; expert witness for both plaintiff and defense; and behind the scenes LNC roles for both plaintiff and defense firms.  She currently does medical malpractice defense work.  She also remains clinically active in critical care.  In addition to decades of critical care experience, Judy has been a nursing school director and instructor, and has experience in nursing administration and flight nursing.  She has a master’s degree in nursing from University of Oklahoma, and a master’s degree in health law, from the Sheppard Broad Law Center, Nova Southeastern University, Ft. Lauderdale, FL.

WHEN: October 28, 2014 – Social (light food) & Networking – 5:30 – 5:45 PM; Chapter Update Meeting 5:45 – 6:00 PM; and Education Program 6:00 – 8:00 PM.

CONTINUING EDUCATION CREDITS: 2.0 contact hours, as part of the total hours of continuing education required for initial licensure and biennial renewal, FL Administrative Code 64B9-5.011.  Approved by The Greater Orlando Chapter AALNC, FL Board of Nursing Continuing Education Provider #: 50-13.  LNCCs – This topic qualifies as contact hours that can be applied toward LNCC certification renewal.  If you are submitting this program as contact hours on application for LNCC renewal, report these hours on the application as nursing contact hours.

WHERE:  PLEASE NOTE NEW LOCATION!!!  We are now holding our Greater Orlando Chapter AALNC Meetings at University of Central Florida (UCF).  The street address is UCF Continuing Education, Innovative Center, 3280 Progress Drive, Suite 700, Orlando, FL 32826,  Room 722.

REGISTRATION:  If you plan to attend the meeting in person, PLEASE RSVP by contacting:  info@orlandoaalnc.org.  If you are a guest, please provide your name, address and FL nursing license number for continuing education credit and course completion certificates.

**NEW REGISTRATION INFORMATION:  Members and guests will be able to attend the program in person or “virtually” by logging in online.  Registration to attend the meeting online, will be completed through UCF Continuing Education.  Information regarding the online registration process will be sent ASAP.  The program will also be available for online attendance at any time after the live meeting.

FEES: The meeting / program is free to all Greater Orlando Chapter Members.  There will be a fee for guests:  $25.00 for in person attendance.  Virtual (online) attendance is also free for members, and $25.00 for guests.

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How Can I Tell Whether or Not My Attorney Knows Anything about Florida Board of Nursing or Disciplinary Cases?

indest1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Hiring an attorney can be intimidating and costly. However, hiring representation for a Florida Board of Nursing or disciplinary case is an investment in your future and career. An experienced attorney is indispensable for preparing and defending your case. But how do you know if your representation is knowledgeable in health law?

Below are some examples of what an experienced attorney will not say to a nurse about his or her Board of Nursing or disciplinary case. Remember, if you hear any of the advice below, the attorney most likely has limited or no experience in this area of legal practice.

1. Your attorney tells you that you can argue your case to the Board of Nursing.

Reason:

You cannot “argue your case” in front of the Board of Nursing. If you are at a hearing before the Board of Nursing, it is because you have requested an “informal hearing.”

If you have requested an “informal hearing” this means you do not dispute any of the facts alleged against you in the Department of Health (DOH) complaint. If you are not disputing the facts, this means you are agreeing that you are guilty. If you are at a hearing in front of the Board of Nursing, you will not be allowed to argue that you are not guilty, and you will not be allowed to call any witnesses or introduce any documents. You are only there for the purpose of determining how much punishment the Board will give you and this is based on guidelines that the Board has previously enacted.

2. If your attorney tells you that he or she does not intend to submit any information or documents for consideration by the Probable Cause Panel (PCP) of the Board of Nursing.

Reason:

Many cases are dismissed by the Probable Cause Panel (PCP) and this is the easiest, most expedient, and least expensive way of winning your case. However, your presentation (written only) that is submitted to the PCP must be direct, concise, directly address the legal issues, and be well organized. It is not advisable to try to prepare this yourself. We often include affidavits from our own expert witnesses that have reviewed the case. If the PCP does not vote in favor of probable cause, the case is dismissed and closed. It is like it never happened. There is no record kept of the initial complaint.

The PCP of the Board of Nursing consists of between two and four members. Some of these can be laypersons with no experience in your area of healthcare. A majority has to vote and decide that there is probable cause. Therefore, if there are only two members, and you convince one that you did not do it, then there is no probable cause.

In my opinion, this is the best and quickest way to win your case, but you must know what you are doing. There are exceptions to every rule.

3. If your attorney tells you to meet with the DOH investigator or to give a statement (written or oral) to the investigator, especially without being present or preparing you.

Reason:

DOH investigators are similar to police. If you give them any statement, this can be used to prove the case against you. In most cases, you never want to do this. Although there may be a rare exception, we strongly advise the client against this in about 99% of the cases we handle.

Even if you believe that you are totally innocent, your former employer, the unhappy patient who reported you, or the DOH prosecuting attorney may be convinced that you are not innocent and recommend that charges are prosecuted against you. Exhibit 1 used against you at a hearing will be your own statement. The first witness the DOH prosecutor will call to testify will be you.

Be smart in such matters. Don’t think you can just explain the case away. Don’t give evidence that can be used against you. It is not required under Florida law, and you cannot be compelled to do this.

4. If your attorney says you should call and negotiate with the DOH attorney, or PRN/IPN case manager.

Reason:

As discussed above, anything you say can and will be used against you. This is one of the main reasons you should retain an experienced attorney: to act as a buffer between you and the legal system, to protect you, and shield you from mistakes you make that could hurt your defense.

Additionally, if your attorney is not much more familiar with the DOH and the PRN/IPN procedures than you are, then why have you hired him or her?

5. If your attorney tells you not to worry about the hearing, you can later appeal.

Reason:

Only about 20% of cases are won on appeal. On appeal, the Court of Appeal is limited to the record of the hearing that was held. You are not allowed to reargue the facts in an appeal. You are limited to arguing about legal errors that were made during the hearing. If you don’t know the law, you are unable to effectively appeal.

6. If your attorney tells you that he or she can represent you during the investigation but is unable to “try” your case at an administrative hearing.

Reason:

Representation only through the PCP hearing stage simply is not enough. An attorney should have sufficient knowledge, experience, and skill to represent you throughout the entire case. If he or she does not, and formal administrative charges are recommended by the PCP, you will then need to retain a completely new attorney who will need time, effort, and legal fees to learn your case in order to properly represent you.

Additionally only an attorney who has experience in litigation cases against the DOH and your professional board will have the credibility and experience to negotiate the most favorable deal for you if you later desire to settle the case.

Consult With An Experienced Health Law Attorney.

We routinely provide deposition coverage to registered nurses (RNs), advanced registered nurse practitioners (ARNPs), certified registered nurse anesthetists (CRNAs), licensed practical nurses (LPNs), nurse midwives and nurse practitioners and other health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing registered nurses (RNs), advanced registered nurse practitioners (ARNPs), certified registered nurse anesthetists (CRNAs), licensed practical nurses (LPNs), nurse midwives and nurse practitioners in investigations at Board of Nursing hearings. Call now or visit our website www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

Florida Bill to Expand Authority of Nurses Flatlines During 2014 Legislative Session

5 Indest-2008-2By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar   in Health Law

The 2014 Legislative Session ended May 2, 2014, with the death of an omnibus health bill. House Bill 7113 would have provided provisions to expand the power of nurse practitioners to work independently of physicians’ oversight. This extension of authority to nurses would no longer require them to contract with and pay a “supervising” physician. The bill died after being passed back and forth between the Florida House of Representatives and the Florida Senate numerous times. It could not be resuscitated or kept alive by artificial means.

Currently, Florida nurse practitioners must work under direct supervision of physicians. The bill would have changed the title of nurse practitioners or advanced registered nurse practitioners. These are registered nurses with post-college education, usually a Master’s degree. The denied change would have retitled these health professionals to advanced practice registered nurses (APRNs). The bill would have also provided nurses the authority to sign documents that currently require a physician’s signature. This would have included the ability to prescribe controlled substances.

There is a total of 17 states in the United States that have adopted similar bills allowing nurse practitioners to work independently of physicians as APRNs.

To read the entire article from Modern Healthcare, click here.

Conflicting Opinions of the Bill.

Proponents of expanding nurse practitioner autonomy argue that the bill would reduce health care costs in addition to solving a critical shortage of primary care physicians. Because of the high enrollment numbers associated with the Affordable Care Act (ACA), it is anticipated that the need for physicians and health care providers will dramatically increase. Supporters also argue that northerners will be accustom to treatment by nurse practitioners because states such as Connecticut and New York have passed similar bills. They will expect the same level of care when moving to Florida during the winter months.

Opponents of the bill, led by various medical associations, argue the dangers of allocating such power to nurses. They warn that nurses should not have access to prescribing controlled substances without a doctor’s supervision. This argument is defended by highlighting Florida’s constant struggles with high numbers of pill mill busts. The medical associations opposing the bill are passionate in preserving the practice of medicine for the physician. In the end, opponents were granted their wish.

To read more on House Bill 7113, click here for a previous blog.

Even though the bill did not pass this legislative session, we expect this will not be the end of the fight to allow nurse practitioners to work independently of physicians.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent registered nurses, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, midwives and licensed practical nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Is providing a trained nurse practitioner with greater authority to treat and prescribe really a controversial subject? How do you stand on the topic? What benefits or dangers could arise from providing nurses with greater independence? Please leave any thoughtful comments below.

Sources:

“Health Bill Dies in Florida Legislature.” Modern Healthcare. (May 3, 2014). From: http://www.modernhealthcare.com/article/20140503/INFO/305039930

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

 

 

 

 

Will Florida Senate Be Pressured into Expanding the Authority of Nurses?

indest1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On April 28, 2014, the Connecticut House of Representatives approved a bill giving nurse practitioners greater autonomy to diagnose and treat patients without doctors’ oversight. Connecticut is one out of 17 states and the District of Columbia to allow nurse practitioners to work independently of physicians. Similar measures are pending in several other states, including Florida.

The Florida House of Representatives passed the bill (CS/CS/HB 7113) on April 25, 2014, that expands the range of practice for Advanced Practice Registered Nurses (APRNs). The bill is expected to be heard in the Florida Senate soon. If passed, this policy shift would likely lead to profound changes in the way health care is practiced in Florida.

Details of the Florida Bill.

Currently, in Florida, nurse practitioners must work under the supervision of physicians. This bill would change the title of what are usually called nurse practitioners or advanced registered nurse practitioners. These are registered nurses who have post-college education, usually a master’s degree. The proposed change would retitle these health professionals to advanced practice registered nurses (APRNs).

These nurses would gain new authority under the bill, such as the ability to sign documents that now require a physician’s signature, and the opportunity to earn the title “Independent Advance Practice Registered Nurse” after a certain amount of training and experience. Nurse practitioners would no longer have to contract with and pay a “supervising” physician. Another somewhat controversial aspect of the bill is to allow these nurses to gain the authority to prescribe controlled substances.

Increasing Pressure to Pass Similar Bill.

The present Florida bill is being supported as a means to fulfill the anticipated growing need for medical services expected with the implementation of the Affordable Care Act. Especially in certain segments of the medical population, APRNs are already providing a large amount of this care, and the bill acknowledges and grants the authority for this.

With so many states, especially up in the northeast, agreeing to expand the scope of practice to qualified nurse practitioners, we wonder if this will have an effect on the Senate vote in Florida. Snow birds coming to Florida will be comfortable being treated by nurse practitioners and will expect the same level of care when they come down to the Sunshine State.

Opposition May Kill the Bill.

The opposition to this effort is strong and vocal, with the various state medical associations leading the way. For these groups, the issue is one of preservation of the practice of medicine as the domain of the physician. They are accepting of medical practice by physician “extenders,” but not by “providers” who are not physicians. The members of these opposition groups are a formidable force, respected in their communities and able to make significant political contributions. These are not groups that many legislators would want to rankle.

However, a review of the history of medicine in the United States shows that this is a battle the medical doctors are likely to lose. Similar arguments have been made in the past when other types of health care practitioners have sought legal authority to practice their professions. Immediately coming to mind are osteopathic physicians (D.O.s), chiropractic physicians (D.C.s) and midwives (CMs) to name a few. Some have had to bring antitrust lawsuits to obtain relief.

Be sure to check this blog regularly for updates to this story.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent registered nurses, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, midwives and licensed practical nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at http://www.TheHealthLawFirm.com.

Comments?

What are your thoughts on the bill? Do you think nurse practitioners should have more autonomy? Or do you believe nurse practitioners should be supervised by physicians? Please leave any thoughtful comments below.

Sources:

Altimari, Daniela. “State Moves to Give Nurses Independence From Doctors.” The Courant. (April 28, 2014). From: http://www.courant.com/health/connecticut/hc-aprn-bill-20140428,0,7595375.story

Catala, Paul. “Bill Giving Nurses More Authority Passes House.” Highlands Today. (April 28, 2014). From: http://highlandstoday.com/hi/local-news/bill-giving-nurses-more-authority-passes-house-20140429/

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Florida Nurse Practitioners Fight for Autonomy

indest1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 18, 2014, a bill that would expand the authority of nurse practitioners and would allow some to practice independently of physicians was approved by the Florida House Select Committee on Health Care Workforce Innovations. Despite opposition from physician groups, the bill (PCB SCHCWI 14-01) was overwhelmingly approved 13 to 2. However, some of that support might be fleeting.

To read bill PCB SCHCWI 14-01, click here.

Details of the Bill.

Currently, nurse practitioners work under the supervision of physicians. This bill would change the title of what are usually called nurse practitioners, which are registered nurses who have post-college education, usually a master’s degree, to Advanced Practice Registered Nurses (APRNs). The bill would also apply to specialists, such as certified registered nurse anesthetists (CRNAs), certified nurse midwives and certified nurse practitioners.

These nurses would gain new powers under the bill, such as the ability to sign documents that now require a physician’s signature, and the opportunity to earn the title “Independent Advance Practice Registered Nurse” after a certain amount of training and experience. Nurse practitioners would no longer have to contract with and pay a “supervising” physician. Another controversial aspect of the bill is to allow these nurses to gain the authority to prescribe controlled substances. Currently, Florida is one of the few states that do not allow this.

Supporters and Opponents Cannot Agree.

Even though the vote drew bipartisan support, several committee members said their support was tentative, and that they wanted to see further debate and amendments.

According to Health News Florida, the President of the Florida Senate reported he opposes the House bill. Many physician groups, including the Florida Medical Association, agree. These groups point out that physicians receive years of additional training to provide care. They also raise the question why students would want to rack up huge amounts of debt to attend medical school if they could do much of the same work as nurse practitioners with less schooling.

Supporters state this bill will help increase access to primary care, particularly in rural areas. Nurse practitioners also state they already provide much of the care that physician groups bill for. It’s argued that similar laws are already in place in a majority of states around the country, according to The News Service of Florida. To read the entire article from The News Service of Florida, click here.

Expanded Scope of Practice for Nurse Practitioners Already Working in Other States.

According to Health News Florida, 23 other states already allow independent practice for nurse practitioners. Also, military services and the Veterans Administration Health System, already allow nurse practitioners to prescribe controlled drugs and allow independent practice. Florida is the only state that prohibits nurse practitioners from prescribing controlled substances.

According to Health News Florida, the issue is not expected to be considered during the upcoming Legislative session. Click here to read the entire Health News Florida article.

Be sure to check this blog regularly for updates to this story.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent registered nurses, nurse practitioners, advanced registered nurse practitioners, certified registered nurse anesthetists, midwives and licensed practical nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at http://www.TheHealthLawFirm.com.

Comments?

What are your thoughts on the bill? Do you think nurse practitioners should have more autonomy? Or do you believe nurse practitioners should be supervised by physicians? Please leave any thoughtful comments below.

Sources:

Saunders, Jim. “Nurse Practitioners Win First Round In Fight Over ‘Scope.'” The News Service of Florida. (February 22, 2014). From: http://www.theledger.com/article/20140222/NEWS/140229772/1374?Title=Nurse-Practitioners-Win-First-Round-In-Fight-Over-8216-Scope

Gentry, Carol. “Senate Pres.: No On Nurses’ Bill.” Health News Florida. (February 24, 2014). From: http://health.wusf.usf.edu/post/senate-pres-no-nurses-bill

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

Appealing Final Orders and Emergency Suspension Orders (ESOs) from the Florida Board of Nursing

indest1By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The professional boards for licensed health professionals in Florida, such as the Board of Nursing, are all under the Florida Department of Health (DOH).  Each board is responsible for disciplinary actions and other matters regulating the professions under its authority.  The investigators and attorneys assigned for Board of Nursing matters all work for or are assigned to the DOH.  The Florida DOH is headed up by the Florida Surgeon General.  I think of the DOH as the umbrella agency over the professional boards or as a parent corporation which owns many subsidiary corporations.

Administrative Procedures Governing Investigations and Disciplinary Actions.

All agency actions, especially disciplinary actions and investigations, are governed by the Florida Administrative Procedure Act (APA), Chapter 120, Florida Statutes.  The Florida APA is modeled after the Federal Administrative Procedure Act.  However, in addition to the Florida APA, DOH investigations and hearings may also be governed by several different provisions of Chapter 456, Florida Statutes, a set of laws which govern all licensed health professionals.

For example, Section 456.073, Florida Statutes, gives certain procedural steps that must be followed in investigations and probable cause hearings involving complaints against nurses and other health professionals.  Section 456.073(13), Florida Statutes, is a new section added several years ago that provides a six (6) year “statute of limitations” for many disciplinary matters;  but there are many exceptions to this.

Section 456.074, Florida Statutes, gives the Surgeon General the authority to issue emergency suspension orders (or ESOs) in certain cases.  Section 456.076, Florida Statutes, authorizes the establishment of treatment programs for impaired health professionals and offers some alternatives to disciplinary action.  To date, the only recognized programs are the Intervention Project for Nurses (IPN) (which covers all nursing professionals) and the Professionals Resource Network (PRN) (which covers almost all other health professionals).  Section 456.077, Florida Statutes, authorizes nondisciplinary citations for certain offenses.  Section 456.078, Florida Statutes, authorizes mediation for certain offenses.

Mistaken Advice Regarding Appeals.

We are often consulted by nurses after they have an emergency suspension orders (or ESOs) entered against them or after they have a Final Order for disciplinary action entered against them.  We often hear that they consulted an attorney who advised them at an earlier stage of the proceedings, after they received a letter from a DOH investigator advising that they were being investigated, to not worry about putting together or presenting any defense at that stage.  We often hear that they consulted an attorney who advised them not to dispute the charges at a formal administrative hearing or not to request a formal administrative hearing.  We are told that they have been mistakenly advised that they should just wait and file an appeal because they are more likely to win on appeal.

This is, of course, incorrect advice.  If you compare these proceedings to criminal investigations, would any competent attorney advise you to not worry about preparing for a trial or contesting the charges at a trial?  Would any competent attorney advise you to just wait until you are convicted, because you could then file an appeal?  No, of course not.  This is because appeals are based on legal defects in the proceedings and do not involve any presentation of new facts that are not already in the record.  Additionally, very few cases are reversed on appeal, whether criminal, civil or administrative in nature.  So why give up your best shots at winning a case:  presenting a good case of factual information and documents at the investigation level or disputing the charges at a formal hearing?

Don’t Try to Be Your Own Attorney on an Appellate Matter.

There are, of course, many valid legal grounds for appeals of ESOs and Final Orders.  However, you have to understand the law and the procedural rules that govern such matters in order to be able to identify them and argue them on appeal.  In addition, appellate law is a legal specialty of its own.  If you are not familiar with researching case law and writing legal briefs, you should not be attempting to appeal your own case.  Would you attempt to perform brain surgery on yourself?  If so, you should get your head examined.  The courts of appeal are far more exacting in their requirements than trial courts are.  See The Florida Rules of Appellate Procedure.  However, most Florida courts of appeal also have their own local rules which may apply to appeals.

Grounds for appeal of an ESO include that less restrictive means of protecting the public were available or that the conduct alleged does not meet the legal requirement for imposing such a suspension.  Grounds for appeal of a Final Order include that the punishment it gives exceeds the disciplinary guidelines that each board has and that proper procedures were not followed which deprived the respondent of his or her right to a fair hearing.  There are many other grounds which one who practices regularly before the Board will be able to identify and raise in an appeal.

In many cases, it would be completely useless to appeal an ESO.  You would just waste time and money by doing so, with little or no chance to win or have it reversed.  You might be far better off requesting an expedited formal hearing, to which you are entitled in an emergency suspension case, and get your case heard as soon as possible.  You need the advice and guidance of an experienced attorney to help you figure out what the best course of action is in your case.

Where to Appeal May Be an Issue.

The notice of appeal must be filed with the clerk of the DOH.  However, a copy must also be filed with the appropriate appellate court having jurisdiction.  The First District Court of Appeal in Tallahassee will have jurisdiction in almost all DOH and Agency for Health Care Administration (AHCA) appeals.  However, the District Court of Appeal which has jurisdiction over the county in which the respondent health professional resides will also have jurisdiction.  If the appellate case law of one of these is more favorable than the other, from a strategic viewpoint, it may be better to file in the one with the more favorable case law.

Alternative Actions to an Appeal May be Appropriate.

Furthermore, there may be more effective and less expensive methods of obtaining relief from an ESO or Final Order than an appeal.  If you are subject to an ESO, you have the right to an expedited hearing.  Sometimes this will result in quicker relief than appealing it.  If you are subject to a Final Order that has been issued in error or there was some mistake in the proceedings that led up to it, the Board may be inclined to reconsider the matter and amend it.  This would require you to file a motion for reconsideration with the Board itself.

Always Carry Professional Liability Insurance that Includes Licensure Defense Coverage.

We continue to recommend that all nursing personnel, especially those who work in hospitals, nursing homes or for agencies, carry your own professional liability insurance.  If you do purchase insurance, make sure it has professional license defense coverage that will pay for your legal defense in the event a complaint is filed against your nursing license.  Usually coverage of up to $25,000 comes with most good nursing liability policies.  There are many companies that sell such insurance for as little as $100 per year.  However, if you can get additional coverage, $50,000 is more likely to cover any foreseeable investigations, hearings and appeals.  Even higher limits can be purchased for a few dollars more from many insurance companies.

Seek Legal Advice and Prepare Your Defenses Early.

Always seek legal advice as soon as you suspect there may be a complaint of any kind or an investigation of any kind.  Don’t hide your head in the sand and think that the investigation could not possibly be about you.  Talk to an attorney before you talk to anyone else.  A good attorney will help to save you from making mistakes that could compromise a good legal defense.

Call the attorneys of The Health Law Firm to set up a consultation on any of the above issues. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Did you find this blog helpful? Please leave any thoughtful comments below.

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Tips, Pointers and Reminders for Administrative Hearings

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Formal administrative hearings are one of the options provided to a person who has significant (or substantial) interests that will be affected by agency action and who contests the material facts involved in the case.

In this blog, we are usually discussing a hearing involving the professional license of the nurse. In many cases this will be a notice of intent to deny a license application; however, in most cases, it will be based on an administrative complaint filed against the nurse charging the nurse with a violation of the Nurse Practice Act or other misconduct.

A formal administrative hearing is the only chance which is provided to a nurse to actually challenge the facts of the case and show, for example, that she is not guilty of the charges alleged against her. The formal administrative hearing is the only proceeding in which the nurse against whom the complaint is filed (called the “respondent”) may confront the evidence against her (documents and witnesses) and introduce her own evidence (including her own testimony, if desired), to show she is not
guilty of the charges.

Formal administrative hearings are governed by the Florida Administrative Procedure Act (APA), Chapter 120, Florida Statutes. Please see the separate chapter in this Manual on the Administrative
Procedure Act.

Our Tips, Pointers and Reminders for Administrative Hearings.

This is a partial checklist of some of the matters we check in preparing for administrative hearings. It is not complete and it may not apply in every case. It should serve as a reminder of certain issues that
should be checked up on prior to the actual date of the hearing.

1. If you need one, make sure to notify the ALJ or make a reservation for a televison monitor, VCR/DVD, projector, screen, or conference phone early (when the original order setting the hearing is received), and follow up with a confirmation letter to the hearing coordinator.

2. Make sure all witnesses testifying have been listed in your answers to interrogatories, and if not, amend your answers to include all witnesses. Also, check the witness list for the pre-hearing stipulation.

3. File all discovery responses/answers immediately when received, with the Clerk of the Division of Administrative Hearings, using a notice of filing, so these will be in the official record. If there is discovery not answered, do a motion to compel (except with requests
for admissions).

4. Some administrative law judges have ceratin procedures they require or certain things they don’t allow in hearing procedures. It is a good idea to check with someone else who has appeared before the ALJ to find out if that ALJ has any.

5. Go onto the Division of Administrative Hearing website, search for and review the last few recommended orders (ROs) and Final Orders on your administrative law judge ahead of time. This will give you an idea of what the administrative law judge is like and how he/she has ruled on various issues in the past. The DOAH website is (www.doah.state.fl.us). Go to case search, put in ALJ’s name and agency name (for example DOH) to obtain Recommended Orders on similar cases.

6. On the day of the hearing, get to the room at the final hearing site early to organize and re-set the room if necessary, to choose where you want to sit. Rearrange the room, if necessary to have a proper hearing setting to create one large conference able in the middle, as most administrative law judges seem to prefer this.

7. Investigation reports are inadmissible as hearsay. You must object to them if the DOH attorney attempts to introduce one.

8. Also, settlement negotiations (including the transcript or minutes of Board meeting at which a settlement stipulation was considered, and any statements made by the respondent or anyone else in support of it are inadmissible, per Rule 90.408 (civil) and Rule 90.410
(criminal) of the Rules of Evidence.

9. Affidavits are considered hearsay evidence, but since this is an administrative hearing the ALJ may allow one or more into evidence, if it is being used to corroborate previously admitted evidence.

10. If you want to introduce an affidavit at hearing and you have the witness who made the affidavit available, have the witness present, have the witness take the stand and testify from the affidavit.

11. Bring a copy of the most recent DOAH court docket for case, to be able to prove that a document was or was not filed.

Although not directly applicable to a formal administrative hearing involving a nursing license case, the following checklist which we use for formal hearings involving Medicaid benefits, may also be useful to you.

Contact Health Law Attorneys Experienced in Representing Nurses Administrative Hearings.

The Health Law Firm’s attorneys routinely represent nurses in administrative hearings, depositions, Department of Health investigations, before the Board of Nursing, and in appearances before the Board of Nursing in licensing matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Preparing for a Deposition for Nurses

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

With the number of personal injury and healthcare-related lawsuits increasing each year, at some time in your professional career as a nurse, you will receive a subpoena requiring you to give an oral statement at a deposition. Having your deposition taken can be a stressful or even a scary experience. Following the few simple tips set forth in this chapter can make your deposition experience less stressful and hopefully relieve your feelings of anxiety.

Before the Deposition 

1. Be Prepared -You should prepare yourself for your deposition by familiarizing yourself with the chart or other medical records at issue in the lawsuit, unless your attorney instructs you otherwise. You should be prepared to answer general knowledge questions regarding the issues involved in the lawsuit. The examining attorney does not expect an in depth medical response; however, using some medical terminology may add to your credibility as a professional. Again, it is imperative that you realize your role in the case prior to deposition in order to assist in your preparation. If you have used certain medical terms in your nurse’s notes or medical record be sure you know exactly what they mean. If you used an abbreviation, be sure you know what it means.

2. Contact Your Attorney and Demand a Preparation Meeting – If you work in a hospital, you can probably expect the hospital’s attorney to conduct a predeposition conference to familiarize you with the plaintiff’s theory of the case when a hospital is being sued as an employer. Keep in mind that this attorney is not your attorney, but is your employer’s attorney; therefore, you may wish to retain a board certified healthcare attorney or a litigation attorney to be “on your side” for the deposition. If you are not contacted several weeks prior to your deposition regarding preparation for it, call your attorney and demand an appointment no later than one week prior to the deposition. This will give you time to meet with the attorney, learn about the issues involved in the suit, learn more about your role in the lawsuit, time to reschedule the meeting or have a follow-up meeting and time to relax before your deposition. Ask your attorney if he or she has a videotape of other depositions (from a different case) or a training videotape for you to watch. A training videotape can be particularly useful if you have never been deposed before. If your attorney does not conduct a pre-deposition conference with you, you are not receiving proper legal representation. Ask for a new attorney who has the time to properly prepare you for your deposition.

3. Ask If You Can Sit in on Other Depositions Before Yours – Although this may not be permitted in some cases, in many cases it will be. Consult with your attorney.

4. Do Not Discuss the Case With Others – Never discuss the case with others, unless your attorney is present or advises you it is ok to do this. If anyone tries to talk to you about the case, do not. If anyone asks you questions about the case, immediately advise them you have an attorney and that person should speak with your attorney.

5. Visit the Location of the Deposition – Unless the deposition will be held in your hospital or office, drive to the location where it will be held ahead of time and check out the parking situation. If you do this, you will not be rushed or late on the day of the deposition.

6. Pick Out Your Deposition Clothes – Pick out and prepare your deposition clothes prior to the deposition.

7. Obtain and Review Your Employer’s Medical Abbreviations List – If you work for a hospital, facility or group that has a “standard medical abbreviations list,” obtain it and review it. Check the records you wrote (after consulting with your attorney) to see if you used any incorrectly; if you did use an abbreviation incorrectly, be prepared to explain what you meant and why you used the abbreviation.

At the Deposition

1. Dress Professionally – As a general rule, unless your attorney advises you that it is okay to wear a nursing uniform, wear your best professional suit or “church clothes.” Regardless, be sure that your clothes are freshly cleaned and not in need of tailoring or repair. If in doubt, take what you plan to wear to your pre-deposition meeting with your attorney.

2. Do Not Be Intimidated – In some cases, an examining attorney will attempt to harass or intimidate a deponent during a deposition. If you have your own attorney present, she or he will attempt to curtail these types of tactics. If you begin to feel pressured, pause and take a breath before you begin your answer. Answers that are not thought out are the answers that the examining attorney will use to destroy your credibility as a witness.

3. Tell the Truth – When being deposed, you are under a sworn oath to tell the truth. Therefore, it is of the utmost importance that you give only truthful information to the deposing attorney. The truth is the easiest to remember and will help you deal with any psychological intimidation or other tactics that a hostile interrogating attorney might use. Harassment usually occurs when the attorney thinks that the witness is deliberately misstating or withholding relevant facts. Keeping your answers truthful may help reduce this type of behavior by the examining attorney.

4. Give Direct Answers – Give direct, straightforward responses without rambling or exaggerating and without volunteering information that was not requested. It is easy to be mislead into “telling all” by a friendly opposing attorney. Keep in mind that the deponent is only required to give knowledge that he or she personally has. If you do not know the answer to the question, you should state that you do not have personal knowledge of the information being asked. Remember, when an attorney for the other side is asking questions, the best answer is the shortest truthful answer. The best answer will usually be: “Yes,” “No,” “I don’t know,” or “I don’t recall.” If one of these answers applies, use it. Do not volunteer information. Additionally, do not guess the answer to the question. Similarly, do not state your opinion; give only facts of which you have personal knowledge. Keep your answers honest, straightforward and direct.

5. Listen Carefully – It is important that the deponent listen very carefully to the question asked by the attorney. Many times, attorneys do not prepare questions or rehearse questions in preparation for a deposition. As a result, some of the questions asked by the deposing attorney may be poorly worded, confusing or may be asked in many parts. Give only the answer to the question asked.

6. Ask the Attorney to Rephrase or Reask the Question – The questions asked should be completely understood. If you have listened carefully and you are asked a question that you do not understand, it is proper and appropriate to request that the attorney rephrase the question. You should not feel anxious or embarrassed to request that the question be rephrased.

7. Only Answer Questions Within Your Scope of Work – In some cases, you may be asked medical questions that are outside your knowledge or scope of practice. It is certainly appropriate for you to say that you do not know the answer to the question or that the information is beyond your knowledge as a nurse. You should not answer questions involving subjects about which you are not knowledgeable. It is also proper to state if you do not remember the answer to a question.

8. Stay Calm – While being deposed, attempt to stay calm, relaxed and composed throughout the deposition. This type of behavior will enhance your credibility as a witness. You should not be concerned with how your answers will affect others involved in the lawsuit. Be sure to take your time in answering the questions asked. You should not feel rushed to answer the questions; after all, the attorney deposing you subpoenaed you for the deposition.

9. Speak Clearly – Speaking clearly will also aid you in the deposition. A court reporter is recording everything you are saying. Therefore, you must orally answer every question. It will also assist to curtail rambling if you remember that a court reporter is recording every word you speak.

10. Be Polite – Being polite and cooperative can only help your position. Even though an attorney may attempt to intimidate you, being polite and cooperative will hinder his ability to make you feel uncomfortable.

11. Never Lose Your Temper – Never lose your temper or allow yourself to lose control. Some attorneys will try to get you to do this so you will say something without thinking.

12. No Joking – Do not laugh or joke around immediately before, during or after a deposition. This is a serious matter. Treat it seriously. Never relax your guard around the opposing attorney. He is not your friend.

13. Pause Before Answering – Pause two seconds before you answer each question. This will give you time to think. This will also give your attorney time to object if the question is improper.

14. Stop Immediately if Someone Else Speaks – If anyone else starts to speak, stop talking immediately. If your attorney objects, listen very carefully to the objection. Your attorney may be trying to tell you something.

After your Deposition 

After being deposed, if you made any mistakes in your deposition or later remember an answer, notify your attorney immediately. It is probably not too late to correct it.

You have the right to obtain a copy, check and change any errors or mistakes (even ones you made) in the typed transcript of the deposition. Never waive your right to obtain a copy and read the deposition transcript (unless your attorney has advised you of a good reason to do this before the deposition). Demand that you receive a copy of the transcript so you can review it prior to your later testimony at the trial (which may be years later). Always demand a copy of the transcript with all of the exhibits attached to it.

You have the right to review the entire transcript, correct any typographical errors or any erroneous statements you may have made and file these corrections with the transcript. You can only do this if you exercise your right as a deponent to “read and sign the transcript.” This is very important. Never agree to waive “reading and signing” unless you have discussed it with your attorney before the deposition and you have received a good reason you should do this.

If you will be called as a witness at the trial or in a related case, always review the transcript of your deposition twice, once approximately one week before and again the night before you testify.

Again, until the entire case is over and finalized (only your attorney can tell you when this is), do not discuss the case with anyone else.

Contact Health Law Attorneys Experienced in Representing Nurses at Depositions.

The Health Law Firm’s attorneys routinely represent nurses in depositions, Department of Health investigations, before the Board of Nursing, in appearances before the Board of Nursing in licensing matters, and in administrative hearings.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Nurses: Don’t Work at an Illegal Health Care Clinic

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Despite the passage of Florida’s Health Care Clinic Act over nine years ago, there are still many health practices which are violating it. Unfortunately, the violation of the Health Care Clinic Act can have serious repercussions, including conviction of a felony, loss of all fees collected, and disciplinary/licensure action against any nurses or other licensed health professionals working there.

Over the past three years we have seen the following scenarios or ones similar to these (changed factually to ensure anonymity):

Scenario 1: A health care practitioner licensed in Florida decides to sell her practice and retire. Three non-licensed business people decide to form a corporation to purchase and operate the practice. The corporation purchases the medical practice’s assets, including patient records. The corporation has not applied for or received a health care clinic license.

Results: On the day of closing or the day the practice is transferred to the new corporation, the corporation is operating illegally, in violation of Florida law. Each day of operation is a separate felony.

Scenario 2: A health care professional practices medicine through a limited liability company (LLC) which the he owns with his non-licensed wife. The health care professional dies and his wife remains sole owner of the practice, hiring a locum tenens physician to come in and treat patients.

Results: As of the date of death of the health care professional, the practice is operating illegally, in violation of Florida law. Each day of operations is a separate felony offense.

Scenario 3: A health care professional licensed in Florida operates a medical practice as a sole proprietorship. The health care professional desires to reward her practice manager, a non-licensed business person, by making him a partner in her practice. The practice continues to operate as before without a health care clinic license.

Results: The practice is operating illegally as of the day the practice manager is made a partner.

Scenario 4: A health care professional has a medical practice which he owns and operates through a business corporation which does not need or have a health care clinic license. He decides to relocate to another state. He sells the shares of stock to a medical doctor who is licensed in Georgia, but is not licensed in Florida. The new physician owner hires a medical doctor licensed in Florida to deliver all medical services in the Florida practice.

Results: The corporation, its owner, and the physician employee are operating illegally as of the date the shares in the corporation are transferred. Each day of operation constitutes a new offense.

The consequences of such actions are severe. The act provides that violating it constitutes a felony of the third degree for each day of operation. Any licensed health professional having knowledge of the unlicensed status of the practice or clinic and who does not immediately report it can be disciplined by his or her professional board. Any fees of any kind collected from any source, Medicare, Medicaid, insurers, or cash from patients, are considered illegal as a matter of law and are subject to recoupment or refund.

If you are a nurse or other licensed health professional, be sure you know who the actual owners of the medical practice are. If any are not licensed in Florida, inquire as to the existence of a current, valid health care clinic license from the Agency for Health Care Administration. If any doubt or suspicion, consult with an experienced health care attorney.

Don’t Wait Too Late;  Consult with an Experienced Health Law Attorney At the Onset of Any Issue

Do not wait until action has been taken against you to consult with an experienced attorney in these matters. It is much easier to win your case when there is proper time to prepare.

The attorneys of The Health Law Firm are experienced in representing nurses, nurse practitioners, and CRNAs in investigations, IPN matters and at Board of Nursing hearings.  Call now or visit our website www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.